Advance Directives

Self-Determination and Living Wills

Presenting the Policy of Willis-Knighton Health System in Accordance with Louisiana Law.

According to Louisiana law, all persons have the right to control decisions relating to their own medical care, including the decision to have life-sustaining procedures withheld or withdrawn in instances where the individual involved is diagnosed as having terminal and irreversible illness.

In order to make one’s wishes known to his/her physician and other healthcare workers, a person has the right to make a declaration specifying those wishes in the event he/she becomes incompetent or is otherwise unable to make those wishes known.

To help you be informed on this important subject, this brochure includes Willis-Knighton’s policy statement regarding such declarations made through a Living Will or through Power of Attorney. Also included is a summary of Louisiana’s law on this subject.

If you have previously executed any of these documents, you should promptly notify your physician and provide him or her and hospital personnel a copy that can be made a part of your medical record.

If you have not done so, we urge you to discuss this issue with your physician, family and clergy so that your desires for treatment are clearly understood by all.

Sample forms are available on each nursing unit if you desire to complete one while hospitalized. Because these forms are written for the general public, they may not meet your specific needs. In such a case, you may want to consult with your attorney to have a document drafted to meet your specific needs.

Willis-Knighton is committed to providing the best possible healthcare to all patients, regardless of their wishes regarding life support or advance directive. Please feel free to contact your patient representative, social worker, nurse or physician about any questions you may have about this subject. We will do our best to answer your questions or to direct you to the proper sources for answers.

Purpose: To allow competent adult patients the right to make decisions concerning healthcare, which includes the right to accept or refuse any proposed medical or surgical treatment and to permit the withholding or withdrawal of life-sustaining procedures on behalf of an irreversible terminal patient or a patient in a continual profound comatose state with no reasonable chance of recovery.

Policy:
Decisions to forgo life-sustaining procedures should generally be made by the patient (or surrogate) and the physician after such discussion of therapeutic options as is reasonably possible under the circumstances. When a decision is made to forgo life-sustaining procedures, the dignity of the individual is to be preserved and measures to foster the patient’s comfort, including nursing care, personal hygiene and analgesics, shall be maintained.

Procedure: A NO CODE/DO NOT RESUSCITATE or other order directing the withholding or withdrawal of specified life-sustaining procedures may only be given by Physician Order.

A DECLARATION is a mechanism by which resuscitation or life-sustaining procedures may be refused. When life-sustaining procedures are to be withheld or withdrawn or an order is given in accordance with a verbal or written declaration by the patient (or if the patient’s surrogate, the attending physician and one other physician must certify in writing that the patient is in a continual profound comatose state with no reasonable chance of recovery).

In the event of any conflict regarding a decision concerning resuscitation or life-sustaining procedures, the Ethics Committee shall be consulted to assist in resolution.

Terminal and Irreversible Condition:
Continual profound comatose state with no reasonable chance of recovery, or a condition caused by injury, disease or illness which, with reasonable medical judgment, would produce death and for which the application of life-sustaining procedures would have only to postpone the moment of death. Act 321 R.S. 1299.58.2 (8) 1991

Designating Another Person: If an adult person has not made a prior declaration regarding his/her treatment decision, the law permits him/her to designate another person to make the treatment decision and make such a declaration for him/her in the event he/she is diagnosed as having a terminal and irreversible condition and is unable to participate actively in medical decisions in his/her own behalf. In such a circumstance, the person may execute a Durable Power of Attorney (the person designated need not be a lawyer) in the following or a similar form, signed and dated by declarant and signed by two witnesses

A Summary of Louisiana Law Related to Decisions Regarding Life-Sustaining Procedures and Declarations

1299.58.1
The legislature finds that all persons have the fundamental right to control the decisions relating to their own medical care, including the decision to have life-sustaining procedures withheld or withdrawn in instances where such persons are diagnosed as having a terminal and irreversible condition.

1299.58.2 Definitions
Life-Sustaining Procedure – Any medical procedure or intervention, including but not limited to the invasive administration of nutrition and hydration, which, within reasonable medical judgement, would serve only to prolong the dying process for a person diagnosed as having a terminal and irreversible condition. A “life-sustaining procedure” shall not include any measure deemed necessary to provide comfort care. Act 320 of 1991, effective R.S. 40:1299.58.2.(4)

Qualified Patient – A patient diagnosed and certified in writing as having a terminal and irreversible condition by two physicians who have personally examined the patient, one of whom shall be the attending physician. R.S. 1299.58.2 (7) 1991 Act 221

Terminal and Irreversible Condition – Continual profound comatose state with no reasonable chance of recovery or a condition caused by injury, disease, or illness which, within reasonable medical judgment, would produce death and for which the application of life-sustaining procedures would have only to postpone the moment of death. Act 321 R.S. 1299.58.2 (8) 1991

Declaration – A witnessed document, statement or expression voluntarily made by the declarant authorizing the withholding or withdrawal of life-sustaining procedures, in accordance with the law. A declaration may be made in writing, orally or by other means of nonverbal communications. R.S. 1299.58.2. (2)

Declarant – A person who has executed a declaration.

Witness – A competent adult who is not related to the declarant or qualified patient, whichever is applicable, by blood or marriage and who would not be entitled to any portion of the estate upon the decease of the person from whom life-sustaining procedures are to be withheld or withdrawn.

1299.58.3
(1) Any adult person may, at any time, make a written declaration.
(2) A written declaration must be signed in the presence of two witnesses.
(3) An oral or nonverbal declaration may be made by an adult in the presence of two witnesses.

1299.58.4 A declaration may be revoked at any time by the declarant.

1299.58.5 Any of the individuals in the following order of priority may make a declaration on a qualified patient’s behalf:

A. The judicially appointed tutor or curator.
B. The patient’s spouse not judicially separated.
C. An adult child of the patient.
D. The parents of the patient.
E. The patient’s siblings.
F. The patient’s other ascendants or descendants.

1299.58.6
The following individuals may make a declaration for the benefit of a terminally ill minor:

The spouse if age of majority is reached.

Either parent or guardian.

1299.58.7 (B)
Any attending physician who refuses to comply with the declaration shall make a reasonable effort to transfer the patient to another physician.

1299.58.10 (A)
Nothing in this Part shall be construed to condone, authorize or approve mercy killing or euthanasia or to end life other than to permit the natural process of dying.

(B) The provisions in this Part shall not constitute a suicide.

(B.5) The removal of life support shall not be deemed the cause of death for insurance coverage.

(D) A declaration properly executed in and under the law of another state is deemed